Article

Staged surgical treatment for symptomatic vertebrobasilar artery stenosis: combined treatment with endovascular angioplasty and bypass surgery.

Department of Neurosurgery, University of Tokyo, Tokyo, Japan.
World Neurosurgery (impact factor: 0.68). 12/2011; 78(1-2):90-4. DOI:10.1016/j.wneu.2011.12.006 pp.90-4
Source: PubMed

ABSTRACT Because the early risk of stroke recurrence in patients with posterior circulation infarctions is high, patients with vertebrobasilar events require active preventive treatment. Previous reports have described the use of balloon angioplasty and stenting or surgical revascularization to the vertebrobasilar artery area. To compensate for the disadvantages of these techniques, we combined endovascular and surgical treatments in a patient with symptomatic vertebrobasilar artery stenosis.
After endovascular surgery, we continued medical therapy to stabilize the blood flow in the posterior circulation. Superficial temporal artery-superior cerebellar artery bypass was planned for the chronic stage (∼1-2 months).
Three cases (2 vertebral artery stenosis, 1 basilar artery stenosis) presented with recurrent transient ischemic attacks or deteriorating symptoms under intensive medical treatment. We conducted staged therapy using balloon angioplasty followed by superficial temporal artery-superior cerebellar artery bypass. All patients were symptom-free after treatment with the combined therapy.
Our staged therapy may be an effective treatment for symptomatic vertebrobasilar artery stenosis.

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Keywords

1 basilar artery stenosis
 
2 vertebral artery stenosis
 
active preventive treatment
 
balloon angioplasty
 
blood flow
 
cases
 
chronic stage
 
effective treatment
 
endovascular
 
endovascular surgery
 
intensive medical treatment
 
medical therapy
 
posterior circulation
 
posterior circulation infarctions
 
recurrent transient ischemic attacks
 
Superficial temporal artery-superior cerebellar artery bypass
 
surgical treatments
 
symptomatic vertebrobasilar artery stenosis
 
vertebrobasilar artery area
 
vertebrobasilar events
 

Takahiro Ota